W3: Disorders of Childhood
Disorders of Childhood Key words:
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder Intellectual Disability
Neurodevelopmental disorders Dopamine
Inattention Hyperactivity Impulsivity
Psychostimulant medication Ritalin
DEX/ATX
Cognitive training
Echolalia Theory of Mind Sally Anne task Eye tracking studies Synaptic pruning
Applied behaviour analysis (ABA) antipsychotic medication
Down Syndrome Fragile X syndrome Williams syndrome
Fluorescent In Situ Hybridization (FISH) Elastin
Neurodevelopmental disorders
ONSET = developmental period, usually before child starts school Characterised by developmental deficits in:
Personal, social, academic and/or occupational functioning Often co-occur, can be specific impairment OR global (across domains) Not just deficits and delays – also behaviours in excess
Impulsivity – e.g. talking over the top of other people
Symptoms can be the same across different diagnosis- for example, attention difficulty is common in down syndrome, adhd etc
ADHD
Behavioural disorder – INATTENTION, HYPERACTIVITY and IMPULSIVITY
Onset – before 12yrs (Half are diagnosed before 6yrs - more severe= easier to recognise) 9 is the mean age.
For a diagnosis – must occur across domains (e.g. school, home) Must differ from normal at that age
Adults only need to show symptoms in 5 domains (6 for kids)
Prevalence = variable data bc diagnostic critea (DSM-IV vs ICM etc), different funding models (require diagnosis for funding) and location BUT no evidence that it is
increasing
More common in boys than girls.
Research not as common in girls-more research has been done into boys with ADHD Lifelong – symptom severity decreases tho – perhaps learnt to deal with symptoms
e.g. Adults with ADHD have jobs BUT lower SES and change jobs more often Causes
Heritability estimates of 70-80% from adoption and twin studies.
A single gene is unlikely to account for ADHD-Interaction of different genes, and environment – most likely.
But dopamine (receptor and transporter genes) seem to be involved
W3: Disorders of Childhood
Early birth
Neurobiological: Smaller dopaminergic areas, less activation in frontal areas, reduced brain volume, delayed maturation etc
Environmental: Maternal smoking, alcohol use, maternal stress, low birth weight, nutritional, exposure to lead or pesticides, family adversity or low income
Treatment
Psychostimulant medication: Methylphenidate/Ritalin, Dexamphetamine (DEX), Atomoxetine (ATX)
Effective in the short term.
Have been used for more than 50 years.
Effective in reducing aggressiveness and impulsivity.
Cognitive training – rather than symptom focused – focused on the underlying cause. e.g. running everyday – improves cardiovascular system.
Parent training and change in classroom management- points system, understanding Intensive behaviour treatment
Autism Spectrum Disorder (ASM)
Lifelong developmental condition
Triad of impairment: SOCIAL AND EMOTIONAL DISTRUBANCE, COMMUNICATION DEFICITS and REPETITIVE/RITUALISTIC ACTS
Echolalia: repeat words or phrases over and over Repetitive act (speech)
Deficits in social communication/interaction
Eye tracking studies – ASM spend less time looking at other peoples faces.
Theory of mind – understanding the thought process of someone else.
Deficit in ASD
Sally Ann task – kids with ASM cant recognise that sally doesn’t have the info to know the marble is in the white box.
Increase in diagnosis…Why? broader criteria, more awareness and schools mandated to provide special services
More common in boys Causes:
Premature birth, older fathers – may be linked to ASM.
Increase in early brain growth – problem with Synaptic pruning? might not happen as effectively in ASM – over or under activation
Connectivity and/or abnormal cortical organization in frontal & limbic areas Siblings show more ASD symptoms (without meeting criteria) = genetic
Treatment
Applied behaviour analysis (ABA): intensive operant conditioning
operant conditioning – Teaching kids how to behaviour is certain social environments and rewarding the good behaviour.
Medication – not so effective, not first choice
BUT antipsychotic medication common – can help with comorbid factors
W3: Disorders of Childhood
Treatment for symptoms e.g. sleep (melatonin) and anxiety Intellectual disability
Deficits in intellectual and adaptive functioning ONSET: during development (<18yrs)
Genetic or chromosomal abnormalities:
Down Syndrome
Fragile X syndrome: most common, high comorbidity with ADHD & ASM.
More common in males (XX vs XY female)
Williams syndrome: deletion of multiple genes on chromosome 7, distinct facial and social phenotype (increased approach to unfamiliar people)
Diagnosed through Fluorescent In Situ Hybridization (FISH)-gene present o no
Elastin–reduced levels in Williams syndrome – can cause problems with the organs. E.g. triple bypass surgeries by the time they’re 10.
large part of IQ testing=verbal- WS high verbal functioning but ID in other areas.
Treatment
Residential treatment (require extra care)
Cognitive treatment – strategies to solve problems, computer-assisted programs Behavioural treatments – Early intervention, small sequential steps, teach routines
Summary
ADHD: persistent inattention and/or hyperactivity and impulsivity. More frequent/severe than children of the same age
Autism Spectrum Disorder: Difficulty relating to others, communication and repetitive behaviours. Begins early, diagnosis has risen in recent years.
Intellectual disability: Deficits in intellectual functioning and adaptive behaviour.
Onset=during course of development.
